Financing the efficient delivery of medical services while reducing costs for consumers as well as health care providers is among the most challenging domestic policy problems many countries face. RAND addresses health economics issues through innovative, high-profile research in an effort to improve the efficiency of health care organizations, reduce costs for providers and consumers, and improve financing in health care markets.
In its second term, the Obama Administration can restrain further health care spending growth—without compromising quality—by employing four broad strategies: fostering efficient and accountable providers, engaging and empowering consumers, promoting population health, and facilitating high-value innovation.
Economic evaluations of health care can be used by policy makers and other decision makers to compare the cost effectiveness of different treatment strategies and to make decisions about the allocation of scarce resources, such as dollars spent on health care.
Pay-for-performance (P4P) has been widely adopted, but it remains unclear how providers are responding and whether results are meeting expectations.
More than 40 private sector hospital pay-for-performance (P4P) programs now exist, and Congress is considering initiating a Medicare hospital P4P program. Given the growing interest in hospital P4P, this systematic review of the literature examines the current state of knowledge about the effect of P4P on clinical process measures, patient outcomes and experience, safety, and resource utilization.
To understand what is new in health information technology (IT), the authors updated a systematic review of health IT with studies published during 2004-2007. From 4,683 titles, 179 met inclusion criteria. They identified a proliferation of patient-focused applications although little formal evaluation in this area; more descriptions of commercial electronic health records (EHRs) and health IT systems designed to run independently from EHRs; and proportionately fewer relevant studies from the health IT leaders. Accelerating the adoption of health IT will require greater public-private partnerships, new policies to address the misalignment of financial incentives, and a more robust evidence base regarding IT implementation.
Efforts by countries to attain universal coverage are often hampered by supply constraints that can reduce access to care for those already in the system and, in many Asian and developing countries, by the emergence of informal payment systems that extract under-the-table payments from patients. In 2001, Thailand extended government-financed coverage to all uninsured people with little or no cost sharing.
Test how the implementation of new Medicare post-acute payment systems affected the use of inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), and home health agencies.
Cross-sectional descriptive study describes characteristics of retail clinics, including their location, scope of practice, prices, acceptance of insurance, and ownership, and to estimate the proportion of the U.S. population that lives within a short driving distance of such a clinic.
The authors test whether insurers that experience larger enrollment increases due to Medicare Part D negotiate lower drug prices with pharmacies. Overall, the authors find that 100,000 additional insureds lead to 2.5-percent lower pharmacy prices negotiated by the insurer, and 5-percent reductions in pharmacy profits earned on prescriptions filled by enrollees of that insurer.
Cross-sectional simulation scenarios were developed to estimate the effect of hypertension prevalence, direct medical costs, and quality of life years (QALYs) saved by reductions in sodium consumption. Population-level data on blood pressure, antihypertensive medication use, and sodium intake were from the National Health and Nutrition Examination Survey 1999-2004.
Examines the effects of hospital consolidation on hospital costs and prices to consumers.
The reform legislation moving through Congress includes both promising and unpromising approaches to limiting health care spending.
Life expectancy for U.S. men and women in 2050 may be higher than predicted in official government forecasts, with the result that the costs of Medicare and Social Security could be significantly higher than currently estimated.
Proposes a conceptual framework to guide researchers and policymakers in evaluating waste in the U.S. health care system, implementing waste-reduction strategies, and reducing the burden of unnecessary health care spending.
Evaluates factors that affect the financial performance of hospice.
Advocates of high-deductible health plans, which shift more of the cost of care to individuals, believe that consumers will more carefully assess the balance of health care benefits versus costs, ultimately improving efficiency and quality of care.
In this paper the authors examine the incremental cost of marijuana comorbidity for alcohol, mood and thought diagnoses in hospital settings.
Uses data from California to compare actual prices paid by uninsured patients with prices paid by commercial and Medicare patients. Uninsured patients pay prices similar to those of Medicare patients, and hospital prices to the uninsured have risen.
Data from the Employment Cost Index show that health insurance costs relative to payroll increased 34 percent between 1996 and 2005 and that the increase was largest for businesses paying low wages; simultaneously, data from the Employee Benefits Survey show that benefit packages became less generous, yet cost growth was not paralleled by a commensurate decrease in employer offers.
Examines the discipline of health services research. Often loosely referred to as outcomes research, it is primarily focused on the study of access to care, costs of care, and quality of care.
Most breast cancer care providers in Los Angeles County outside of staff- or group-model HMOs are not subject to explicit financial incentives based on quality-of-care measures. New approaches are needed to direct incentives toward these specialists.
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